Again, Early Antibiotics Are Better for Patients with Severe Sepsis

Authors: Whiles BB et al., Crit Care Med 2017 Feb 6;

In this study, earlier administration was associated with decreased progression to septic shock.

Early antibiotics are associated with decreased mortality for patients with severe sepsis. To evaluate whether early administration of antibiotics is also associated with decreased progression to septic shock, investigators conducted a retrospective cohort study of adult patients who presented to a single emergency department with severe sepsis over an 8-year period.

Among nearly 5000 patients with severe sepsis, approximately 21% presented in septic shock and were excluded. One quarter of the remaining cohort progressed from severe sepsis to septic shock. The median time to initial antimicrobial administration was significantly longer for patients who progressed to septic shock than for those who did not progress (3.77 hours vs. 2.76 hours). Multivariable logistic regression showed an 8% increase in the odds of progression to septic shock for each 1 hour delay in antimicrobial administration. Progression to septic shock and delay in antimicrobial administration were each associated with increased mortality.

Comment

We could quibble with these results if sicker patients were more likely to experience delayed antibiotic administration related to the severity of their disease (e.g., difficult intravenous access or need for intubation). But these results make intuitive sense. We should focus on decreasing time to fluid resuscitation and antibiotics in patients with severe sepsis by using electronic alerts, resuscitation protocols and order sets, and sepsis response teams.